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NYC Hospital Guidance for Responding to a Contaminating Radiation Incident

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NYC Hospital Guidance for Responding to a Contaminating Radiation Incident NYC Hospital Guidance for Responding to a Contaminating Radiation Incident April 2009 Created by NYC Hospital Radiation Response Working Group NYC Department of Health and Mental Hygiene Healthcare Emergency Preparedness Program This publication was supported by Grant Number U3RHS05957-01-00 from the Health Resources and Services Administration. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of HRSA. All inquiries about the “Hospital Guidance for Responding to a Contaminating Radiation Incident” may be addressed to: Healthcare Emergency Preparedness Program c/o NYC Department of Health and Mental Hygiene 125 Worth Street, RM 222, Box 22A New York, NY 10013 Phone: 212-788-4277 or by e-mail at [email protected] List of Contributors NYC Hospital Radiation Response Working Group Chairperson Curt Dill, MD Director Emergency Medicine VA New York Harbor Hospital System Project Manager/Editor Katherine Uraneck, MD Senior Medical Coordinator Healthcare Emergency Preparedness Program NYC Department of Health & Mental Hygiene Joseph Albanese, Ph.D Lewis R. Goldfrank, MD Radiation Biodosimetrist Professor and Chair, Emergency Medicine Yale New Haven Center for Emergency New York University School of Medicine Preparedness and Disaster Response Director, Emergency Medicine Bellevue Hospital/NYU Hospitals/VA Manfred Blum, MD Medical Center Professor of Medicine & Radiology Medical Director NYU School of Medicine New York City Poison Center Bruce Ellerin, MD Christopher Marshall, Ph.D Radiation Oncology Professor Emeritus of Radiology NYU School of Medicine NYU School of Medicine Kent Friedman, MD Rajesh Mittal, MD Assistant Professor of Radiology Emergency Medicine Division of Nuclear Medici SUNY Downstate/Kings County Hospital NYU School of Medicine Center Christopher Freyberg, MD Gabriella Wernicke, MD Director, Emergency Department Associate Professor Radiation Oncology Southern Arizona VA Health Care System Radiation Oncology NYU Clinical Cancer Center Naomi H. Harley, PhD Research Professor Ellen Webb Department of Environmental Medicine Coordinator NYU School of Medicine New York Center for Terrorism Preparedness Bellevue Hospital Center Forward 1. What is this guidance document? The aim of this publication, NYC Hospital Guidance to Responding to a Contaminating Radiation Incident, is to serve as a practical resource for New York City Hospitals in planning a response to an emergency involving radioactive contamination. This guide was developed by The New York City Hospital Radiation Working Group, a multi-hospital working group convened by the NYC Department of Health and Mental Hygiene (DOHMH) that included nuclear medicine, radiation oncology, emergency medicine, health physics, emergency management, mental health, environmental medicine, and radiation-related treatment and monitoring professionals. Every effort has been made to ensure the information in this manual is accurate and consistent with sound radiation protection and assessment methods, policies, and practices. 2. Are the recommendations in this guideline mandatory? The NYC Department of Health and Mental Hygiene (DOHMH) do not require that hospitals incorporate all the following recommendations verbatim. Rather hospitals should develop a radiological emergency plan consistent with their local perceived radiological threat, while considering their staffing capabilities, equipment resources, and other unique characteristics and condition. 3. Why does my hospital need this guideline? The manual assumes that, if a radiological incident occurs, hospitals will activate their Hospital Incident Command System (HICS) and the hospital specific emergency response plan. Each plan should include a radiation-specific annex. If a hospital does not have a radiation annex, this guideline will assist hospital planners and medical staffs create one. Hospitals and their personnel must be able to immediately receive, evaluate and treat victims. Some victims will be ill and injured; some will be exposed and/or contaminated while others who have not been exposed will be concerned about their potential exposure. With little or no warning and information and limited access to radiation specialists, front line staff will be called upon to make complex decisions in an austere environment. To effectively meet this challenge, adequate planning and preparation are necessary. While participation by radiation specialists during planning is critical, the assumption is that adequate numbers of radiation specialists will not be available immediately to perform all essential functions in the event of a radiation emergency. Many tasks must be delegated to the initially available staff. Hence, the Job Action Sheets and appendices were developed to enable non-radiation specialists to perform these essential functions. 4. My hospital plan is to not permit any radiation contamination inside, why do I still need a radiation response annex to my plan? NYC Hospital Guidance for Responding to a Contaminating Radiation Incident i Controlling and limiting contamination is vital, but planners and administrators must understand that some radioactive material will inevitably enter the hospitals if a large scale radiation contaminating incident occurs. The physical properties of radioactive materials, technical limitations of equipment, demand for immediate clinical care, and relative scarcity of radiation specialists make complete exclusion of radioactivity impossible. However, following the radiation control recommendations in this manual the magnitude of contamination should significantly limited, thereby permitting ongoing clinical responsibilities. The manual addresses how to control such contamination, while continuing critical hospital functions and keeping hospital personnel and patients safe. 5. Who should read this guideline? The primary audiences for most of the chapters include emergency planners, administrators, security, radiation safety personnel, and emergency department personnel. The recommendations focus on practical response procedures rather than on treatment protocols with the exception of Section 7: Radiation Medicine. One of the main goals of this document is to adapt the best available knowledge, which is based on the experience gained from treating small numbers of patients, to a potentially overwhelming number in the midst of the chaos of a mass casualty situation. Katherine Uraneck, MD Project Manager and Editor Senior Medical Coordinator Healthcare Emergency Preparedness Program New York City Department of Health and Mental Hygiene NYC Hospital Guidance for Responding to a Contaminating Radiation Incident ii Table of Contents Radiation Abbreviations & Acronyms vi PART I Section 1: Introduction to Planning for a Radiation Incident 1 • Key Planning Considerations for Radiation Incidents 2 • Essential Radiation Concepts and Definition 3 • NYC Radiological Dispersal Device Assumptions 8 Section 2: Staff Safety during a Radiation Incident 9 • Occupational Health 10 • Protective Clothing and Respiratory Protection 11 • Radiation Protection Practices 13 • Radiation Dose Limits for Hospital Personnel 14 • Recommended Occupational Exposure Limits in an Emergency 16 • Radiation Safety Information Sheet for Staff 17 • PROCEDURE: PPE Donning and Doffing 19 • FORM: Employee Exposure Assessment Worksheet 21 Section 3: Radiation Control-Keeping Facilities Safe during a Radiation Incident 22 • Radiation Control General Recommendations 23 • Radiation Control and Safety Team (RCST) 23 • RCST Personnel 24 • Priorities for RCST Members 24 o General Priorities for all Members 24 o Pre-Decontamination Area Priorities 25 o Post-Decontamination Area Priorities 25 o Radiation Control Treatment Area Priorities 26 • General Radiation Contamination Control Practices 26 o RED Control Treatment Area Special Considerations 28 o YELLOW Control Treatment Area Special Considerations 29 o GREEN Control Treatment Area Special Considerations 30 • Radiation Safety Officer Responsibilities 31 • Radiological Surveyors Job Action Sheets (JAS) 32 o General Radiological Surveyors JAS 32 NYC Hospital Guidance for Responding to a Contaminating Radiation Incident iii Table of Contents o Pre-Triage Radiological Surveyors JAS 33 o Post-Decontamination Radiological Surveyors JAS 34 o Red Treatment Area Radiological Surveyors JAS 35 o Yellow Treatment Area Radiological Surveyors JAS 36 o Green Treatment Area Radiological Surveyors JAS 37 • Emergency Dept. Schematic for Placement of Radiation Surveyors & Meters 38 • Establishing Radiation Zones during Radiation Incidents 39 Section 4: Triage and Patient Flow during a Radiation Incident 41 • Introduction to Triage 42 • Medical Triage 42 • Radiological Triage 43 • Prioritizing Radiological Screening of Victims 44 • Hospital Triage Process for Arriving Victims 45 • Summary Flow Chart of Triage Process 47 • Treatment Areas Activities Flow Charts o Red Control Treatment Area Activities 48 o Yellow Control Treatment Area Activities 49 o Green Control Treatment Area Activities 50 • PROCEDURE: Conducting a Rapid Radiological Survey of Crowds 51 • PROCEDURE: Conducting a Rapid Radiological Screening Survey 52 • PROCEDURE: Conducting a Full-Body Radiological Survey of an Ambulatory Person 53 • FORM: Post Decontamination Survey Sheet 55 Section 5: Decontamination of Patients during a Radiation Incident 56 • Patient Decontamination Procedure Recommendations 57 • Decontamination Recommendations for Severely Ill or Injured 57 • Decontamination
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